Typically, a particular community or geographical area has a limited number of trauma centers. These trauma centers are usually segmented into levels, with the highest level trauma centers, that are capable of providing comprehensive service to treat traumatic injuries, being assigned a Level 1 designation while more limited care facilities being assigned a Level 2 or 3 designation. Thus, trauma victims may be triaged (e.g., assigned a trauma category, which may correspond with a level designation for a trauma center) based on a set of criteria. The patient can then be transported or otherwise delivered into the care of a trauma center with a level corresponding to the assigned category.
Trauma Center designation is a process outlined and developed at a state or local level. The state or local municipality identifies unique criteria in which to categorize Trauma Centers. These categories may vary from state to state and are typically outlined through legislative or regulatory authority. Following are exemplary definitions of various trauma center levels, as defined by the American Trauma Society (ATS). Other definitions are also possible.
A Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury—from prevention through rehabilitation. Elements of Level I Trauma Centers Include:                24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care.        Referral resource for communities in nearby regions.        Provides leadership in prevention, public education to surrounding communities.        Provides continuing education of the trauma team members.        Incorporates a comprehensive quality assessment program.        Operates an organized teaching and research effort to help direct new innovations in trauma care.        Program for substance abuse screening and patient intervention.        Meets minimum requirement for annual volume of severely injured patients.        
A Level II Trauma Center is able to initiate definitive care for all injured patients. Elements of Level II Trauma Centers Include:                24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care.        Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I Trauma Center.        Provides trauma prevention and to continuing education programs for staff.        Incorporates a comprehensive quality assessment program.        
A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations. Elements of Level III Trauma Centers Include:                24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists.        Incorporates a comprehensive quality assessment program        Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center.        Provides back-up care for rural and community hospitals.        Offers continued education of the nursing and allied health personnel or the trauma team.        Involved with prevention efforts and must have an active outreach program for its referring communities.        
A Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center. It provides evaluation, stabilization, and diagnostic capabilities for injured patients. Elements of Level IV Trauma Centers Include:                Basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage.        Available trauma nurse(s) and physicians available upon patient arrival.        May provide surgery and critical-care services if available.        Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center.        Incorporates a comprehensive quality assessment program        Involved with prevention efforts and must have an active outreach program for its referring communities.        
A Level V Trauma Center provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care. Elements of Level IV Trauma Centers Include:                Basic emergency department facilities to implement ATLS protocols        Available trauma nurse(s) and physicians available upon patient arrival.        After-hours activation protocols if facility is not open 24-hours a day.        May provide surgery and critical-care services if available.        Has developed transfer agreements for patients requiring more comprehensive care at a Level I though III Trauma Centers.        
A facility can be designated an adult trauma center, a pediatric trauma center, or an adult and pediatric trauma center. If a hospital provides trauma care to both adult and pediatric patients, the Level designation may not be the same for each group. For example, a Level 1 adult trauma center may also be a Level 2 pediatric trauma center. This is because pediatric trauma surgery is a specialty unto itself.
Accurately triaging patients is difficult. In most cases, the triaging occurs in a pre-hospital setting such as when first responders or emergency medical service personnel are assessing or transporting the patient. Appropriate triage of trauma patients is vital for efficient utilization of trauma resources and the delivery of appropriate care. Under triage (assignment of a lower triage category to a patient that should be assigned a higher triage category) is extremely problematic, as the patient may not receive appropriate care. Over triage (assignment of a higher triage category to a patient that should be assigned a lower triage category) can also be problematic by forcing patients out of their community unnecessarily, wasting resources, and delaying treatment for those critically injured.